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Background Intensity-modulated radiation therapy (IMRT) yields better outcomes and fewer toxicities for radiation therapy (RT) of head and neck cancers (HNCs), including nasopharyngeal cancer (NPC). IMRT is the standard RT treatment and has been widely adopted in Western countries to treat HNCs. However, its uptake in clinical practice among NPC patients has never been studied. Methods We investigated the use of IMRT for NPC using data from a nationwide cancer registry to describe the use of IMRT among NPC patients in Japan. We analyzed the data of patients with HNC, including NPC, who underwent IMRT between 2012 and 2014, as recorded in the hospital-based cancer registries linked with insurance claims. We calculated the proportion of patients with NPC who underwent IMRT at each hospital. To evaluate the use of IMRT for NPC, the IMRT use for NPC was compared with the proportion of patients with prostate cancer who underwent IMRT. Results Among 508 patients with NPC who underwent RT at one of 87 hospitals, 348 (69%) underwent IMRT. This proportion gradually increased between 2012 and 2014 (62%, 64% and 77%). Meanwhile, 4790 patients with prostate cancer (90%) underwent IMRT. Although some hospitals where IMRT was performed treated many patients with NPC, the proportion of patients with NPC who were treated with IMRT was low. Conclusions IMRT has not been widely adopted in Japan for treating NPC. Barriers for adopting its use should be identified to close the gap between the standard and actual medical practice in Japan.

Background Quality indicators (QIs) for primary care are used worldwide. To date, however, the use of QIs to assess the quality of primary care in Japan has not been reported besides diabetes care. Here, we used QIs to evaluate the quality of primary care services provided by local clinics in Japan. Methods Four primary care clinics participated in the retrospective medical chart review in 2015. To assess primary care quality, we used 18 process‐oriented QIs from the Quality Indicators for Primary Care practice in Japan (QIPC‐J) those we previously developed by using a modified Delphi appropriateness method, which comprises 39 QIs in five categories (Comprehensive care/Standardized care, Access, Communication, Coordination, and Understanding of patient's background). Adult subjects were selected from among patients who visited each clinic within the previous one year using medical claims data. We collected data by reviewing medical charts, and calculated the quality score for each QI and clinic. Results A cumulative total of 4330 medical charts were reviewed. The overall quality score was 31.5%. Adherence to QIs ranged from 3.2% to 85.6%. Some quality scores varied substantially between clinics but the overall quality of care among clinics varied less, from 29.2% to 34.0%. Conclusions The quality of primary care services provided by local clinics in Japan varies by both QI and clinic. Strategies to improve the quality of care are warranted.

We regret that this article is behind a paywall., Safe and efficacious pan-genotypic direct-acting antiviral (DAA) regimens, such as sofosbuvir and daclatasvir (SOF+DCV)facilitate simplified models of care for hepatitis C virus (HCV). However, in Cambodia access to HCV testing and treatment has typically been low. In response, Médecins Sans Frontières(MSF) implemented a HCV testing and treatment pilot project in Phnom Penh, Cambodia in 2016. This project provides the first real-world evidence of SOF+DCV effectiveness across a large patient cohort using a simplified care model in Cambodia.Patients treated with SOF+DCV from September 2016 to June 2019 were included in the analysis. Medical standard operational procedures (SOPs) were simplified significantly across the study period. Treatment effectiveness was assessed by sustained viral response at 12 weeks post-treatment (SVR12) according to a modified intention to treat methodology. Treatment safety was assessed by clinical outcome and occurrence of serious and non-serious adverse events (S/AE). Of 9158 patients, median age was 57 years and 39.6% were male. At baseline assessment, 27.2% of patients had compensated cirrhosis and 2.9% had decompensated cirrhosis. Genotype 6 was predominant (53.0%). Among patients analysed according to modified intention to treat (n=8525), treatment effectiveness was high, with 97.2% of patients achieving SVR12. Occurrence of SAE was low (0.7%). Treatment effectiveness and safety was not affected by the iterative simplification to treatment modality. In conclusion, in this large treatment cohort in Phnom Penh, Cambodia, the SOF+DCV regimen showed high rates of treatment effectiveness and safety across patient sub-groups and during progressive simplification.

Background: Simplifying hepatitis C virus (HCV) screening is a key step in achieving the elimination of HCV as a global public health threat by 2030. Objectives: The objective of this study was to demonstrate the agreement of capillary blood and venipuncture specimens when using SD Bioline© HCV, a low-cost rapid diagnostic test (RDT), prequalified by WHO in 2016 on venous blood samples. Study design: Recruitment was conducted prospectively among adult patients presenting for HCV testing at the Medecins Sans Frontieres (MSF) clinic of Preah Kossamak Hospital (Phnom Penh, Cambodia) between October and November 2017. Capillary and venous blood samples were collected from consenting patients and tested with SD Bioline© HCV. Two independent, blinded readers, and in the case of disagreement, a third reader, interpreted the results of each blood sample. Concordance between results was compared using Cohen's Kappa interrater reliability statistic. Discrepant sample pairs were tested with an enzyme immunoassay, the reference standard, at the Institute Pasteur of Cambodia. Results: Among 421 pairs of samples collected, reader disagreement occurred for 0.7% (n = 3) of the participants. Sixty-four percent of capillary and venous blood sample pairs tested positive for HCV, with a Kappa statistic of 0.985 between the two methods. Three participants with discrepant sample pair results tested positive with EIA. Conclusions: Capillary and venous blood samples were concordant when tested with HCV SD Bioline© in a clinical context. This simplified testing approach is essential to the scale-up of HCV screening and useful in resource-limited settings or among populations for whom venipuncture is problematic.

Author(s): Walker, Josephine; Mafirakureva, Nyashadzaishe; Marquez, Lara; Stone, Jack; Lim, Aaron G; Campbell, Linda; Khalid, Gul Ghuttai; Iwamoto, Momoko; Aslam, Khawar; Wailly, Yves; Zahid, Hassaan; Donchuk, Dmytro; Fortas, Camille; Falq, Gregoire; Soe, Kyi Piar; Chaillon, Antoine; Re Iii, Vincent Lo; Wynn, Adriane; McIntosh, Craig; Johnson, Derek; Zosso, Jean-Marc; Nguyen, Aude; Kiene, Susan; Brodine, Stephanie; Garfein, Richard; Hastings, Reuben; Kimchamroeun, San; Le Paih, Mickael; Dousset, Jean-Philippe; Balkan, Suna; Marquardt, Tonia; Mucara, Esther; Gonzalez, C Ines; Kizito, Walter; Nzomukunda, Yvonne; Cherutich, Peter; Cleland, Charles; Lizcano, John; Chhun, Nok; Kurth, Ann; Musyoki, Helgar; Bhattacharjee, Parinita; Waruiru, Wanjiru; Mundia, Ben; Maman, David; Luhmann, Niklas; Coast, Joanna; Loarec, Anne; Martin, Natasha; Vickerman, Peter

Background & aims: In 2016, Médecins Sans Frontières established the first general population Hepatitis C virus (HCV) screening and treatment site in Cambodia, offering free direct-acting antiviral (DAA) treatment. This study analysed the cost-effectiveness of this intervention. Methods: Costs, quality adjusted life years (QALYs) and cost-effectiveness of the intervention were projected with a Markov model over a lifetime horizon, discounted at 3%/year. Patient-level resource-use and outcome data, treatment costs, costs of HCV-related healthcare and EQ-5D-5L health states were collected from an observational cohort study evaluating the effectiveness of DAA treatment under full and simplified models of care compared to no treatment; other model parameters were derived from literature. Incremental cost-effectiveness ratios (cost/QALY gained) were compared to an opportunity cost-based willingness-to-pay threshold for Cambodia ($248/QALY). Results: The total cost of testing and treatment per patient for the full model of care was $925(IQR $668-1631), reducing to $376(IQR $344-422) for the simplified model of care. EQ-5D-5L values varied by fibrosis stage: decompensated cirrhosis had the lowest value, values increased during and following treatment. The simplified model of care was cost saving compared to no treatment, while the full model of care, although cost-effective compared to no treatment ($187/QALY), cost an additional $14 485/QALY compared to the simplified model, above the willingness-to-pay threshold for Cambodia. This result is robust to variation in parameters. Conclusions: The simplified model of care was cost saving compared to no treatment, emphasizing the importance of simplifying pathways of care for improving access to HCV treatment in low-resource settings. Keywords: Markov process; cost-effectiveness; direct-acting antiviral treatment; healthcare costs; hepatitis C; low-income population; treatment costs.

In Cambodia, little epidemiological data of hepatitis C virus (HCV) is available. All previous studies were limited to only small or specific populations. In the present study, we performed a characterization of HCV genetic diversity based on demography, clinical data, and phylogenetic analysis of HCV non-structural 5B (NS5B) sequences belonging to a large cohort of patients (n = 3,133) coming from majority part of Cambodia between September 2016 and December 2017. The phylogenetic analysis revealed that HCV genotype 1 and 6 were the most predominant and sharing equal proportions (46%). The remaining genotypes were genotype 2 (4.3%) and unclassified variants (3.6%). Among genotype 1, subtype 1b was the most prevalent subtype accounting for 94%. Within genotype 6, we observed a high degree of diversity and the most common viral subtypes were 6e (44%) and 6r (23%). This characteristic points to the longstanding history of HCV in Cambodia. Geographic specificity of viral genotype was not observed. Risks of HCV infection were mainly associated with experience of an invasive medical procedure (64.7%), having partner with HCV (19.5%), and blood transfusion (9.9%). In addition, all of these factors were comparable among different HCV genotypes. All these features define the specificity of HCV epidemiology in Cambodia.

Introduction: To the best of our knowledge, no quality indicators (QIs) for primary care provided by local clinics have yet been developed in Japan. We aimed to develop valid and applicable QIs to evaluate primary care in Japan. Methods: Two focus group interviews were held to identify conceptual categories. Existing indicators for these categories were identified, and initial sets of potential QIs were developed. Using a modified Delphi appropriateness method, a multidisciplinary expert panel then developed and selected the QIs. Feasibility and applicability of these QIs were then confirmed in pilot testing at six local clinics in Hokkaido, Japan. To determine patient acceptance of these quality improvement activities, the survey asked two questions, “Do you think it is preferable that the patients of this clinic be periodically surveyed?” and “Do you think it is preferable that this clinic periodically undergo an external quality review by an independent body?” Results: Seven categories emerged from the focus group discussions as key components of primary care in Japan. Thirty-nine QIs under five categories (Comprehensive care/Standardized care, Access, Communication, Co-ordination, and Understanding of patient background) were finally selected and named the QIs for Primary Care Practice in Japan. In pilot testing at six primary care clinics in 2015, 65.4% of patients answered favorably to the idea that clinics should conduct regular patient surveys, and 71.8% answered favorably to the idea that clinics should undergo periodic external quality review by an independent body. Conclusions: We developed QIs to assess primary care services provided by clinics in Japan, for the first time. Although further refinement is required, establishment of these QIs is the first step in quality improvement for primary care practices in Japan.

Radiotherapy and bevacizumab are each effective in treating patients with advanced cancer, but their concurrent use may cause serious adverse events (SAEs). Whereas sequential administration can theoretically reduce the risk of SAEs while maintaining the anticancer effects, this hypothesis remains unconfirmed, leading to variations in practice. To elucidate current practices, the patterns of care received by patients in Japan with regard to these two therapies were assessed in a large database of a hospital-based cancer registry linked with insurance claims. This database contained information on 106 057 patients diagnosed with seven major cancers in 2011 and the care they received up to the end of 2012. In total, 335 patients from 101 hospitals in the database were treated with both radiotherapy and bevacizumab. Of these patients, 50.8% had lung cancer, and 51.3% had Stage IV cancer. Of the 335 patients, 75 (22.4%) received these therapies concurrently. In patients treated sequentially, the time from the last dose of bevacizumab to the start of radiotherapy was most frequently 4–5 weeks (12.4%), whereas the time from the end of radiotherapy to the start of bevacizumab was most frequently 1–2 weeks (10.6%). The cumulative proportions of patients in these two groups receiving sequential therapies within 3 weeks were 19.0% and 26.1%, respectively. Many practices appeared to avoid the concurrent use of bevacizumab and radiation, but some provided concurrent therapy. Additional data are required to determine whether the avoidance of concurrent use should become a standard of care.

Simplifying hepatitis C virus (HCV) screening is a key step in achieving the elimination of HCV as a global public health threat by 2030.The objective of this study was to demonstrate the agreement of capillary blood and venipuncture specimens when using SD BiolineRecruitment was conducted prospectively among adult patients presenting for HCV testing at the Médecins Sans Frontières (MSF) clinic of Preah Kossamak Hospital (Phnom Penh, Cambodia) between October and November 2017. Capillary and venous blood samples were collected from consenting patients and tested with SD BiolineAmong 421 pairs of samples collected, reader disagreement occurred for 0.7% (n = 3) of the participants. Sixty-four percent of capillary and venous blood sample pairs tested positive for HCV, with a Kappa statistic of 0.985 between the two methods. Three participants with discrepant sample pair results tested positive with EIA.Capillary and venous blood samples were concordant when tested with HCV SD Bioline

GeneXpert® (Cepheid) is the only WHO prequalified platform for hepatitis C virus (HCV) nucleic acid amplification testing that is suitable for point‐of‐care use in resource‐limited contexts. However, its application is constrained by the lack of evidence on genotype 6 (GT6) HCV. We evaluated its field performance among a patient population in Cambodia predominantly infected with GT6. Between August and September 2017, we tested plasma samples obtained from consenting patients at Médecins Sans Frontières’ HCV clinic at Preah Kossamak Hospital for HCV viral load (VL) using GeneXpert® and compared its results to those obtained using COBAS ® AmpliPrep/Cobas® TaqMan® HCV Quantitative Test, v2.0 (Roche) at the Institut Pasteur du Cambodge. Among 769 patients, 77% of the seropositive patients (n = 454/590) had detectable and quantifiable VL using Roche and 43% (n = 195/454) were GT6. The sensitivity and specificity of GeneXpert® against Roche were 100% (95% CI 99.2, 100.0) and 98.5% (95% CI 94.8, 99.8). The mean VL difference was −0.01 (95% CI −0.05, 0.02) log10 IU/mL for 454 samples quantifiable on Roche and −0.07 (95% CI −0.12, −0.02) log10 IU/mL for GT6 (n = 195). The limit of agreement (LOA) was −0.76 to 0.73 log10 IU/mL for all GTs and −0.76 to 0.62 log10 IU/mL for GT6. Twenty‐nine GeneXpert® results were outside the LOA. Frequency of error and the median turnaround time (TAT) for GeneXpert® were 1% and 0 days (4 days using Roche). We demonstrated that the GeneXpert® HCV assay has good sensitivity, specificity, quantitative agreement, and TAT in a real‐world, resource‐limited clinical setting among GT6 HCV patients.

The importance of measuring the quality of cancer care has been well recognized in many developed countries, but has never been successfully implemented on a national level in Japan. We sought to establish a wide-scale quality monitoring and evaluation program for cancer by measuring 13 process-of-care quality indicators (QI) using a registry-linked claims database. We measured two QI on pre-treatment testing, nine on adherence to clinical guidelines on therapeutic treatments, and two on supportive care, for breast, prostate, colorectal, stomach, lung, liver and cervical cancer patients who were diagnosed in 2011 from 178 hospitals. We further assessed the reasons for non-adherence for patients who did not receive the indicated care in 26 hospitals. QI for pretreatment testing were high in most hospitals (above 80%), but scores on adjuvant radiation and chemoradiation therapies were low (20-37%), except for breast cancer (74%). QI for adjuvant chemotherapy and supportive care were more widely distributed across hospitals (45-68%). Further analysis in 26 hospitals showed that most of the patients who did not receive adjuvant chemotherapy had clinically valid reasons for not receiving the specified care (above 70%), but the majority of the patients did not have sufficient reasons for not receiving adjuvant radiotherapy (52-69%) and supportive care (above 80%). We present here the first wide-scale quality measurement initiative of cancer patients in Japan. Patients without clinically valid reasons for non-adherence should be examined further in future to improve care.

Objective The state of opioid consumption among cancer patients has never been comprehensively investigated in Japan. The Diagnosis Procedure Combination claims data may be used to measure and monitor opioid consumption among cancer patients, but the accuracy of using the Diagnosis Procedure Combination data for this purpose has never been tested. Methods We aimed to ascertain the accuracy of using the Diagnosis Procedure Combination claims data for estimating total opioid analgesic consumption by cancer patients compared with electronic medical records at Aomori Prefectural Central Hospital. We calculated percent differences between estimates obtained from electronic medical records and Diagnosis Procedure Combination claims data by month and drug type (morphine, oxycodone, fentanyl, buprenorphine, codeine and tramadol) between 1 October 2012 and 30 September 2013, and further examined the causes of discrepancy by reviewing medical and administrative charts between April and July 2013. Results Percent differences varied by month for drug types with small prescription volumes, but less so for drugs with larger prescription volumes. Differences also tended to diminish when consumption was compared for a year instead of a month. Total percent difference between electronic medical records and Diagnosis Procedure Combination data during the study period was -0.1% (4721 mg per year per hospital), as electronic medical records as baseline. Half of the discrepancy was caused by errors in data entry. Conclusion Our study showed that Diagnosis Procedure Combination claims data can be used to accurately estimate opioid consumption among a population of cancer patients, although the same conclusion cannot be made for individual estimates or when making estimates for a group of patients over a short period of time.

Objective: Differences in hospital case-mix have not been adequately accounted for in hospital volume and patient outcome studies in Japan. We aimed to examine whether differences may exist by investigating the distribution of patients’stage and age across designated cancer treatment hospitals of varying patient volume across Japan. Methods: We analyzed data of gastric, breast, colorectal, lung and liver cancer patients who were included in the national database of hospital-based cancer registries between 2008 and 2011. We investigated the association between hospital volume, cancer stage and patient age. Hospitals were classified into five groups according to patient volume. Results: In total, 676 713 patients met the inclusion criteria. The proportion of patients with earlystage (tumor–node–metastasis Stage 0 or I) cancer was higher among high-volume hospitals for all cancer types except small cell lung cancer. The proportion of older patients (age >75 years) was smaller among high-volume hospitals for all cancer types. The difference in the proportion of patients with early-stage cancers between very low-volume and very high-volume hospitals was greatest for non-small cell lung cancer (26.5% for very low and 43.5% for very high). This difference for the proportion of older patients was also greatest for non-small cell lung cancer (48.9% for very low and 30.3% for very high). Conclusions: We showed that the proportions of early-stage cancer patients and younger patients are greater in higher-volume hospitals compared with lower-volume hospitals in Japan. Researchers conducting volume–outcome studies and policymakers analyzing hospital performance should be cautious when making interhospital comparisons.

The International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer did not take into account any of the findings determined by imaging modalities as part of the staging work-up. However, in the Japanese clinical settings, computed tomography (CT) and magnetic resonance imaging (MRI) are frequently used. In this study, we aimed to describe the pretreatment use of sensitive imaging modalities in Japan in order to assess the future adaptability of the FIGO staging system.Data from September 2012 to December 2014 were collected from the National Database of the Hospital-Based Cancer Registry and health insurance claims data. A total of 280 hospitals participated. From the database, all patients with cervical cancer who received first-line therapy at the participating hospitals were analyzed. The proportions of patients who had CT, MRI, and positron emission tomography-CT (PET-CT) before receiving the first-line therapy were calculated. For comparison, the proportions of patients who had undergone cystoscopy and/or proctoscopy -- examinations that are incorporated into the FIGO system -- were also calculated. A total of 13 668 patients were included; 77.3% of patients had early stage (stage 0 or I) disease. Among all patients, 88.5% had undergone CT, MRI, or PET-CT before receiving the first-line therapy. Additionally, over 90% of patients with advanced-stage (stage II–IV) disease had undergone CT. Conversely, only 21.0% of patients with stage II–IV disease were reported to have undergone cystoscopy and/or proctoscopy. Promoting a resource-stratified approach in the cervical cancer staging is warranted.

Objective Dependent children under the age of 18 are particularly vulnerable to the stress of parental death from cancer or of having a parent diagnosed and treated for the disease. More and more Japanese couples are postponing parenthood, which increases their chances of developing cancer while they still have a dependent child. However, the problem has not received enough attention from healthcare professionals and policy-makers because the extent and breadth of the problem has never been examined in the Japanese population. Therefore, we aimed to estimate the nationwide incidence of cancer patients who have children under the age of 18 years, as well as the incidence of children who have a parent diagnosed with cancer in Japan. Study design We calculated the proportion of patients who have children stratified by age, gender and cancer type using electronic medical records of cancer patients (20–59 years old) admitted to the National Cancer Center Hospital (NCCH) for the first time between January 2009 and December 2013. We projected these estimates onto the Japanese population using 2010 population-based cancer registry data, and repeated the projection using 2011 hospital-based cancer registry data so that estimates of patients receiving care at Designated Cancer Care (DCC) hospitals could be obtained. Results We found that an estimated 56,143 cancer patients who have 87,017 dependent children are diagnosed with cancer every year in Japan. The proportion of children in Japan who had a parent newly diagnosed with cancer in 2010 was approximately 0.38%. We estimated that in 2011 there were on average about 82 cancer patients with minor children and 128 minor children who have at least one parent diagnosed with cancer in every DCC hospital in Japan. Conclusion Parental cancer is common. We have identified that many adults diagnosed with cancer have the double burden of coping with the diagnosis and treatment as well as supporting their children through this experience. Additional data on socioeconomic characteristics and needs assessment of these patients are required to understand how best to help children and families cope with cancer.

219 Background: Although ensuring high-quality care has a central role in Japanese cancer policy, introduction of a system to evaluate quality is still underway. With the goal of establishing a sustainable measurement system, this study assesses adherence to quality indicators (QIs) as an index for evaluating the quality of care for cervical cancer patients in Japan. Methods: Ten measurable QIs were devised by an expert committee using the modified Delphi method. Adherence to each QI was calculated by using hospital cancer registry data of patients diagnosed during 2013 and claims data between October 1, 2012, and December 31, 2014. Using registry-linked claims data across 281 hospitals, we measured 3 QIs on treatment for CIN3, 3 QIs on stage III or IVA, and 1 QI on stage IVB, respectively. We also measured 1 QI on examination of cancer spread and 1 QI on brachytherapy. Results: Data for 11,925 cervical cancer patients were analyzed. Patients’ mean age was 45.4 years (SD: 15.1). Among the QIs, use of platinum-based chemotherapy among stage IVB patients (99.1%), total hysterectomy as the last treatment among intraepithelial adenocarcinoma patients over age 44 years (87.7%), and selection of cisplatin-based regimen for concurrent chemo-radiation therapy (CCRT) (81.2%) to stage III/IVA diseases marked high adherence. In contrast, evaluation with cystoscope or proctoscope among stage IVA patients (32.4%) and use of CCRT as the initial treatment for stage III or IVA patients (49.5%) had relatively low adherence. Conclusions: The observed variation in adherence to QIs could demonstrate the provision of unstandardized care across Japan. Feedback on the results and continued monitoring are necessary to improve the quality of cervical cancer care.

41 Background: Multiple comorbidities and physiologic decline often prevent older patients from receiving the same standard care provided to younger patients. Therefore, providers who mainly treat older patients may become accustomed to not adhering to standards and thus might be less likely to provide standard care to younger patients. In this study, we compared the care provided to younger patients between facilities that care for a large number of elderly patients and those that treat relatively few older patients. Methods: We used a nationwide registry-linked claims database of 297 hospitals. Among the quality indicators (QIs) we formerly developed, we selected 2 and 3 QIs for lung cancer and gastric cancer, respectively, based on the variation in adherence across facilities. Facilities were divided into 2 groups based on the proportion of older patients (≥75) with each cancer type. We then compared the QI adherence in treating patients younger than 60 years old between the groups. The difference in adherence to standards of care (quality scores) between the 2 groups of facilities was assessed by using a logistic regression model adjusting for patient age and sex. Results: We analyzed data for 6,708 patients with lung cancer and 26,470 patients with gastric cancer. Respective quality scores for facilities with more older patients versus facilities with fewer older patients were 63.4% versus 66.1% (p=0.439) for the EGFR mutation test before the first chemotherapy among stage IV lung adenocarcinoma patients; 63.2% versus 52.5% (p=0.238) for concurrent chemoradiotherapy (CCRT) for localized small cell lung carcinoma patients; 51.6% versus 46.9% (p=0.229) for HER2 test before the first chemotherapy among patients with unresectable gastric cancer; 81.8% versus 79.7% (p=0.354) for Helicobacter pylori test on patients with gastric cancer who had ESD/EMR; and 60.9% versus 60.7% (p=0.948) for adjuvant chemotherapy within 6 weeks among pathological stage II/III gastric cancer patients. Conclusions: Caring for a high proportion of older patients is not associated with diminished provision of standard care to younger patients.

e22544Background: Sarcoma clinical guidelines often emphasize the evaluation of patients by an expert multidisciplinary team, and thus in many countries, care is centralized to treatment centers. However, there are no standard guidelines for referrals of sarcoma patients in Japan, and the overall picture of where and by whom they are treated has never been systematically investigated. Methods: We used hospital-based cancer registry and health claims data of sarcoma patients diagnosed in Japan in 2012 and 2013. We analyzed the distribution of patients across hospitals and the extent of centralization of care across treatment modality and cancer topography. Results: We identified 1032 bone and 7257 soft-tissue sarcoma (STS) patients who were newly diagnosed in 2012 and 2013. Bone sarcomas occurred in the limbs in 55% of the patients, with 73% treated by orthopedic surgeons. Care was weakly centralized to 9 high-volume hospitals ( > 10 new cases per year) and 120 hospitals with 1-9 new cases. Care was greatl...

e17656 Background: Care of pediatric cancer patients is only mildly centralized in Japan, and it is not known whether this has led to variations in treatment practices for pediatric solid tumor pat...